Phylum Platyheminthes

Class of Trematoda
 From the word “trematoda” – meaning “body with holes”
 Leaf-like and hermaphroditic (male and female reproductive system in a single worm) except
Schistosomes which are cylindrical and have separation of sexes
 Prominent feature is the presence of “acetabula” (sucker’s) – oral and ventral
 Usually the digestive tract of flukes is described as having inverted Y figure (Monoecious)
 Life cycle of trematodes:
a. Egg stage
b. Larval stage: Miracidium  Sporocyst  Redia  Cercaria  Metacercaria
c. Adult stage
 Eggs are operculated except for the Schistosomes (non-operculated)
 Infective stage to the final host is the metacercaria (monoecious trematodes) and cercaria
(diecious trematodes – Schistosoma)
 Requires 2 intermediate hosts except for the Schistosomes (only 1 intermediate host)
o 1st intermediate host is usually a snail
o 2nd intermediate host – fish, crab, plant/vegetation, snail
 Fish: Heterophyes heterophyes, Clonorchis sinensis, Opistorchis felineus
 Crab: Paragonimus westermanni
 Plant/ vegetation: Fasciola hepatica, Fasciola gigantic, Fasciolopsis buski
 Snail: Echinostoma ilocanum
 Sub-divided into:
a. Monoecious
 Flattened or leaf-shaped bodies
 Hermaphroditic
 Need two intermediate hosts
 Producing operculate eggs
b. Diecious
 Cylindrical bodies
 Sexes are separate
 Utilizing only one intermediate host
 Producing non-operculate, embryonated eggs (containing miracidium)
 Flukes may also be classified based on the habitat of the adult worm:
a. Intestinal fluke
 Fasciolopsis buski
 Echinostoma ilocanum
 Heterophyes heterophyes
 Haplorchis yokogawai
 Metagonimus yokogawai
b. Lung fluke
 Paragonimus westermani
c. Liver fluke
 Fasciola hepatica
 Clonorchis sinensis
 Opistorchis felineus
  Opistorchis viverrini
d. Blood fluke
 Schistosoma japonicum
 Schistosoma mansoni
 Schistosoma haematobium
A. Monoecious trematodes
Stages of development:Egg  Larva (Miracidium  Sporocyst  Redia  Cercaria 
Metacercaria) Adult
1. Eggs of diecious flukes are already embryonated when laid
2. Miracidium - a free-swimming ciliated embryo that exhibit phototaxis, is provided with
penetration glands that aid in entering the body of intermediate host (attracted to the
mucus secreted by the snail)
3. Once the miracidium is inside the snail intermediate host, it develops into sporocyst
(elongated sac-like structure with a small opening that serves as birth pore) that contains
germ cells that will develop into redia or a second generation sporocyst
4. Redia – a blind and a non-forked cecum with locomotion organelles are release through the
birth pore of the sporocyst and transform to the next stage of development called cercaria
5. Cercaria – a free-swimming, non-feeding larval stage, with penetration glands is attracted to
light (phototaxis)

Types of cercaria:
 Simple-tail lophocercus
 Keel-tailed lophocercus
 Microcercus
 Fork-tailed

6. Cercaria leaves the snail host, (which can be due to death of the snail or overpopulation of
the cercaria) finds the second intermediate host and becomes encysted to become
metacercaria
7. Metacercaria (encysted form)
8. Ingested metacercaria undergoes excystation in the upper level of the small intestine
9. Released microorganism migrates to tissues or organs where is going to mature (liver, lungs,
intestine
LIVER FLUKES

Fasciola hepatica
Common name: Sheep liver fluke
Common disease: Fascioliasis, sheep liver rot

Morphology

Egg
 measures 128 to 150 μm by 60 to 90 μm
 is large, hen’s egg shaped, ovoid with broad operculum, light yellowish brown and immature
when laid

Adult
 Flat, leaf-like with prominent “cephalic cone” at anterior end
 Highly branched intestinal ceca

Laboratory Diagnosis
 The specimen choice for recovery of the eggs
 Enterotest
 ELISA
 Gel diffusion

Clinical Symptoms
Fascioliasis: Sheep Liver Rot
- Persons infected with F. hepatica experience symptoms caused by the presence and attachment of the
adult worm to the biliary tract. These include headache, fever, and chills, and pains in the liver area of
the body (because of tissue damage), some of which may extend to the shoulders and back.
Eosinophilia, jaundice, liver tenderness, anemia, diarrhea, and digestive discomfort are sometimes seen.
Biliary obstruction may also result.

Treatment
- Dichlorophenol (bithionol)

Prevention and Control

Prevention of future potential infections with F. hepatica may be accomplished by exercising proper
human fecal disposal and sanitation practices, particularly in areas in which animal reservoir hosts
reside, controlling the snail population, and avoiding the human consumption of raw water plants or
contaminated water.
Opistorchis felineus
Common name: Cat liver fluke
Most important liver fluke of man
Common Disease: Opistorchiasis or Cat liver fluke

Morphology

Egg
 measures 30 by 15 μm
 The developed miracidium takes up the interior of the egg.
 The egg is equipped with a distinct operculum opposite a small knob.
 A thick rim is strategically located around the operculum and is referred to as shoulders.
 “old fashioned electric bulb”

Adult
 Lancet-shaped with smooth cuticle, attenuate anterior, rounded posterior

Laboratory diagnosis
 Demonstration of eggs in direct fecal smear or duodenal aspirates

Clinical Symptoms
 Most infections are asymptomatic. In mild cases, manifestations include dyspepsia, abdominal
pain, diarrhea or constipation. With infections of longer duration, the symptoms can be more
severe, and hepatomegaly and malnutrition may be present.
 an acute phase resembling Katayama fever (schistosomiasis), with fever, facial edema,
lymphadenopathy, arthralgias, rash, and eosinophilia.

Treatment
 Praziquantel and Albendazole
Clonorchis sinensis
Common name: Chinese liver fluke.
Common disease: Clonorchiasis

Morphology

Egg
 same as Opistorchis felineus “Old fashioned electic bulb”

Adult
 The average adult C. sinensis measures 2 by 0.5 cm
 Flat spatulatem transparent anterior is attenuated,
slightly rounded posterior

Laboratory Diagnosis
 Recovery of the characteristic eggs from stool specimen
 Duodenal aspirates
 Enterotest
 The rarely encountered adult worms are only seen when removed during a surgery or autopsy
procedure.

Clinical symptoms
 Light infections typically occur without any obvious symptoms.
Clonorchiasis
- Persons infected with a heavy worm burden often experience symptoms that include fever, abdominal
pain, eosinophilia, diarrhea, anorexia, epigastric discomfort, and occasional jaundice. Enlargement and
tenderness of the liver and leukocytosis may also occur. Liver dysfunction may result in persons severely
infected over a long period of time.

Treatment
 Praziquantel and Albendazole

Prevention and control

 Include practicing proper sanitation procedures, especially in regard to fecal disposal by the
human and reservoir host (dogs and cats) and avoiding the ingestion of raw, undercooked, or
freshly pickled freshwater fish and shrimp.
 INTESTINAL FLUKES
Fasciolopsis buski
Common name: Large intestinal fluke
 Largest fluke parasitizing man
Common disease: Fasciolopsiasis

Morphology

Egg
 indistinguishable from that of Fasciola hepatica“Hen’s egg shape”

Adult
 Large and fleshy, often elongate ovoid without cephalic cone

Laboratory Diagnosis
 The specimen choice for recovery of the eggs
 Enterotest
 ELISA
 Gel diffusion

Clinical Symptoms
Fasciolopsiasis
 Patients suffering from F. buski infection usually develop abdominal discomfort because of
irritation at the site of worm attachment in the small intestine. This is often accompanied by
inflammation and bleeding of the affected area, jaundice, diarrhea, gastric discomfort, and
edema. These symptoms often mimic those of a person suffering from a duodenal ulcer. Patients
may also suffer from malabsorption syndrome, similar to that seen in patients with giardiasis.
Intestinal obstruction, and even death, although rare, may result.

Treatment
 Praziquantel

Prevention and Control

 Prevention of future potential infections with F. buski may be accomplished by exercising proper
human fecal disposal and sanitation practices, particularly in areas in which animal reservoir
hosts reside, controlling the snail population, and avoiding the human consumption of raw water
plants or contaminated water.
Echinostoma ilocanum
Common name: Garrison’s fluke
 Common in bilibid prisoner
Disease: Echinostomiasis

Morphology

Egg
 straw colored, immature, with a small operculum and oftentimes with a
prominent germ ball inside

Adult
 Reddish-gray when alove, plaque-like scales on cuticle, attenuated posterior, anterior end has a
prominent “circumoral disk” provided with a “collarete of spines” (diagnostic feature)

Laboratory Diagnosis
 Microscopic identification of eggs in the stool. Because the eggs are large, careful
measurements must be taken to avoid confusion with the eggs
of Fasciola or Fasciolopsis. Species-level identification cannot be done based on egg
morphology and adults are needed for a definitive diagnosis.

Clinical Symptoms
 Catarrhal inflammation often occurs due to the penetration of the sharp-spined collar into
the intestinal mucosa. In heavy infections, nausea, vomiting, diarrhea, fever and
abdominal pain may occur.

Treatment
 Praziquantel
Heterophyds (small intestinal flukes)

a. Heterophyes heterophyes
Common name: Von Siebold’s fluke
 Smallest fluke of man but the deadliest
Disease: Superficial necrosis, myocarditis, heart failure, eggs may be filtered into mesenteric cavities,
cardiac valves, myocardium, brain

Morphology:
Egg
 same as Clonorchis sinensis“Old fashioned light bulb”
Adult
 Presence of two ovoid testes of equal size

Laboratory Diagnosis
 The diagnosis is based on the microscopic
identification of eggs in the stool. However, the eggs
are indistinguishable from those ofMetagonimus
yokogawai and resemble those
of Clonorchis and Opisthorchis.

Clinical Symptoms
 The main symptoms are diarrhea and colicky abdominal pain. Migration of the eggs to the heart,
resulting in potentially fatal myocardial and valvular damage, has been reported from the
Philippines.

Treatment
 Praziquantel

Prevention and control

 The easiest and most logistically possible measure to prevent and control Heterophyes is the
avoidance of consuming undercooked fish

b. Metagonimus yokogawai
Common name: Yokogawa’s fluke
Disease: Metagonomiasis

Morphology
Egg
 Similar to Heterophyes heterophyes, “Old-fashioned light bulb”
Adult
 Presence of two ovoid testes of unequal size
Laboratory Diagnosis
 The diagnosis is based on the microscopic identification of eggs in the stool. However, the eggs
are indistinguishable from those of Heterophyes heterophyes and resemble those
of Clonorchis and Opisthorchis. Specific diagnosis is based on identification of the adult fluke
evacuated after antihelminthic therapy, or found at autopsy.

Clinical Symptoms
 The main symptoms are diarrhea and colicky abdominal pain. Migration of the eggs to
extraintestinal sites (heart, brain) can occur, with resulting symptoms.

Treatment
 Praziquantel

Haplorchis yokogawai
 Single, large ovoid testis
 Egg: Similar to Heterophyes heterophyes, “Old-fashioned electric bulb”

LUNG FLUKES

Paragonimus westermani
Common name: Oriental lung fluke
Disease: Oriental distomiasis or paragonomiasis

Morphology
Egg
 ovoid with flattened operculum, posterior part
of shell is thick (thickened aboperculum)

Adult
 thick plump, ovoid, rounded anterior and tapered posterior (coffee bean)
 Vitellaria consist of branching follicles and with zigzag intestinal ceca

Laboratory Diagnosis
 The recovery of eggs in sputum specimens. These eggs are commonly
found in bloody samples. Occasionally, the eggs may be seen in stool
samples when sputum is swallowed. Serologic tests have also been
developed.

Clinical Symptoms
 Paragonimiasis: Pulmonary Distomiasis
 Associated with pulmonary discomfort—cough, fever, chest pain, and increased production of
blood-tinged sputum. Individuals infected with this parasite (the corresponding condition is
known at paragonimiasis and as pulmonary distomiasis) may also experience chronic bronchitis,
eosinophilia, and the production of fibrous tissue. These symptoms often mimic those seen in
persons infected with tuberculosis.

Cerebral Paragonimiasis
 Migration of immature P. westermani organisms to the brain may result in the development of a
serious neurologic condition. Patients experience seizures, visual difficulties, and decreased
precision of motor skills.

Treatment
 Praziquantel

Prevention and control

 the primary prevention and control measures for the eradication of Paragonimus include
avoiding human ingestion of undercooked crayfish and crabs and exercising proper disposal of
human waste products.

B. Diecious trematodes

Stages of development: Egg  Larva (Miracidium  Mother Sporocyst (S1)  Daughter Sporocyst
(S2)  fork-tail cercaria) Adult
1. Adults in natural habitat copulate and female produces eggs
2. Eggs accumulate inside the blood vessels
3. Mucus that comes when eggs are laid causes irritation of the intestinal walls or urinary
bladder resulting to hyperperistalsis
4. Eggs are discharge with the feces or urine
5. Eggs deposited on water are hatch and released the embryo
6. Miracidium finds the intermediate host and enters its body (snail)
7. Inside the intermediate host body, miradium develop into mother sporocyst (S 1) that
later on produces daughter sporocyst (S2), which develops into fork-tail cercaria
8. Fork-tail cercaria(Infective stage) leaves the intermediate host and comes in contact with
the skin of human(definitive host) and penetrate the skin
9. After penetration it reaches its habitat to become adults and copulate to produce eggs

BLOOD FLUKES

Schistosoma japonicum
Common name: Oriental blood fluke
Habitat: Superior mesenteric vessels
Disease: Schistosomiasis japonica, Katayama’s disease

Morphology
Egg
  are embryonated when laid
 is characterized by abbreviated lateral spine or a rudimentary knob on one side
Schistosoma mansoni
Common name: Manson’s blood fluke
 Smallest of blood flukes
Habitat: Inferior mesenteric vessel
Disease: Schistosomiasis mansoni or Mason’s intestinal schistosomiasis or Bilharziasis

Morphology
Egg
 are embryonated when laid
 are characterized with the presence of prominent
lateral spine at the inferior lateral side

Schistosoma haematobium
Common name: Vesical blood fluke
Habitat: Vesical plexuses
Disease: Vesical schistosomiasis or Urinary Bilharziasis or Schistosomal hematuria (bloody urine)

Morphology
Egg
 are embryonated when laid
 are characterized with the presence of prominent
terminal spine

ADULT of Shistosoma spp.

 have separate sexes

 are rounder in appearance
 the typical female measures 2 cm in length and the male measures 1.5 cm,
 the male surrounds the female almost completely, facilitating copulation

Laboratory Diagnosis
 Demonstration of egg in feces, rectal biopsies, urine
 Faust and Meleney’s egg hatching technique
 Circumoval precipitin test of Oliver and Gonzales

Clinical Symptoms

Schistosomiasis, Bilharziasis, Swamp Fever

The first symptom experienced by most symptomatic persons infected
with Schistosoma is inflammation at the cercaria penetration site.
Symptoms of acute infection include abdominal pain, fever, chills,
weight loss, cough, bloody diarrhea, and eosinophilia. Painful urination
and hematuria may also occur in persons infected with S.
haematobium.
Katayama fever - is a systemic hypersensitivity reaction to the schistosomulae migrating through tissue.
Rapid onset of fever, nausea, myalgia, malaise, fatigue, cough, diarrhea, and eosinophilia occur 1 to 2
months after exposure.

Treatment
 Praziquantel
 Oxamniquine is only used for S. mansoni

Prevention and Control

 Older methods of preventing schistosomiasis included proper human waste disposal and control
of the snail population, primarily their breeding areas; prompt diagnosis and treatment of
infected persons, the avoidance of human contact with potentially contaminated water, and
educational programs for the inhabitants of known endemic areas.